The generalized anxiety spectrum: prevalence, onset, course and outcome
The generalized anxiety spectrum: prevalence, onset, course and outcome
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DOI：
10.1007/s00406-008-0832-9
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发表时间：
2009-02-01
影响因子：
4.7
通讯作者：
Roessler, Wulf
中科院分区：
文献类型：
--
作者：
Angst, Jules;Gamma, Alex;Roessler, Wulf
广泛性焦虑症（GAD）通常被认为是一种慢性疾病，在严重程度上有增有减;然而，缺乏对社区样本中GAD病程的前瞻性调查。这项研究试图填补这一空白，通过识别广泛性焦虑综合征的整个谱系，根据其持续时间和发生频率对其进行分型，前瞻性苏黎世研究评估了社区青年样本（N = 591）的精神和躯体综合征。（首次面试时年龄为20岁），在20年（1979-1999年）内进行了6次面试。广泛性焦虑综合征的定义采用DSM-III症状标准，不采用任何排除标准。广泛性焦虑的范围是根据持续时间定义的：6个月（DSM-IV），1个月（DSM-III），千分之一货币符号2周（一年内每周发生一次）和焦虑症状。从1978年（筛查）到1999年，评估了每年出现的症状和治疗情况。焦虑的持续性是指在过去的12个月里几乎每天都出现焦虑症状。在20岁至40岁之间，DSM-III GAD的年发病率显著增加。出现症状的平均年龄为15.6岁; 75%的病例发生在20岁之前。105例DSM-III GAD病例中有75例至少随访一次。在他们个人的最后一次随访中，这75例受试者中有12例（16%）被重新诊断为GAD，22例（29%）表现出阈下综合征或焦虑症状，而39例（大多数）（52%）是无症状的; 12例重新诊断的GAD病例中有5例是持续性的（相当于所有75例初始GAD病例的7%）。在20多岁的时候，他们接受治疗的时间占所有年份的6%，但在30多岁的时候，这一数字上升到12%。在个体末次随访时，26%的6个月GAD受试者和22%的1个月GAD受试者仍在接受治疗。治疗组与未治疗组受试者在性别方面没有差异，但在严重程度、持续性以及与双相II型障碍、社交恐怖症、强迫综合征和物质使用障碍的共病方面存在差异。结果基于相对较小的样本，不能推广到40岁以上的成年人。如前所述，DSM-III定义的GAD的病程可能不是慢性的，但在大约一半的病例中，主要是复发性的，其间有一段无复发的恢复期。在20年的时间里，焦虑谱中的改善多于进展。
Generalized anxiety disorder (GAD) is generally considered to be a chronic condition, waxing and waning in severity; however prospective investigation of the course of GAD in community samples is lacking. This study seeks to fill that gap, by identifying the whole spectrum of generalized anxiety syndromes, sub-typing them according to their duration and frequency of occurrence, and evaluating their long-term course and outcome in the community.The prospective Zurich Study assessed psychiatric and somatic syndromes in a community sample of young adults (N = 591) (aged 20 years at first interview) by six interviews over a period of 20 years (1979-1999). GAD syndromes were defined by DSM-III symptom criteria without applying any exclusion criteria. A spectrum of generalized anxiety was defined by duration: 6 months (DSM-IV), 1 month (DSM-III), a parts per thousand currency sign2 weeks (with weekly occurrence over one year), and anxiety symptoms. From 1978 (screening) to 1999 the annual presence of symptoms and treatment was assessed. Persistence of anxiety was defined by the almost daily presence of symptoms over the previous 12 months.The annual incidence of DSM-III GAD increased considerably between the ages of 20 and 40. The average age of onset of symptoms was 15.6 years; in 75% of cases it occurred before the age of 20. 75 of 105 DSM-III GAD cases had at least one follow-up. At their individual last follow-up, 12 of those 75 subjects (16%) were re-diagnosed as having GAD, 22 (29%) manifested subthreshold syndromes or anxiety symptoms, while 39 cases, the majority, (52%) were symptom-free; 5 of the 12 re-diagnosed GAD cases were persistent (corresponding to 7% of all 75 initial GAD cases). In their twenties they were treated at some time in 6% of all years, but in their thirties this figure rose to 12%. At their individual last follow-up 26% of 6-month GAD subjects and 22% of 1-month GAD subjects were still being treated. Treated vs. non-treated subjects did not differ in terms of gender but did differ in severity, persistence and in comorbidity with bipolar-II disorder, social phobia, obsessive-compulsive syndromes and substance-use disorders.Results are based on a relatively small sample and cannot be generalized to adults aged over 40 years.The course of DSM-III-defined GAD may not be chronic, as previously suggested, but mainly recurrent with intervening symptom-free periods of recovery in about half of cases. Over a period of 20 years there was more improvement than progression within the anxiety spectrum.